| Organization Name: | LAKE FAMILY DENTISTRY PC |
| NPI Number: | 1275804312 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANISH QADRI (PRESIDENT) |
| Mailing Address: | 296 Lake Ave Colonia |
| State: | NJ US |
| Postal Code: | 070671201 |
| Phone Number: | 7323882822 |
| Fax Number: | 7323883115 |
| NPI Enumeration Date: | 01/21/2012 |
| NPI Last Update Date: | 01/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 22DI02351300 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |